Provider Demographics
NPI:1003094517
Name:JOE H CAMPBELL OD LLC
Entity Type:Organization
Organization Name:JOE H CAMPBELL OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:1706-376-5471
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-0727
Mailing Address - Country:US
Mailing Address - Phone:706-376-5471
Mailing Address - Fax:706-376-5483
Practice Address - Street 1:946 BENSON ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-2023
Practice Address - Country:US
Practice Address - Phone:706-376-5471
Practice Address - Fax:706-376-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000938332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5771540001Medicare NSC